Healthcare Provider Details

I. General information

NPI: 1306848551
Provider Name (Legal Business Name): URBAN LEAGUE OF THE UPSTATE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 REGENCY HILL DR
GREENVILLE SC
29607-1230
US

IV. Provider business mailing address

15 REGENCY HILL DR
GREENVILLE SC
29607-1230
US

V. Phone/Fax

Practice location:
  • Phone: 864-244-3862
  • Fax: 864-244-6134
Mailing address:
  • Phone: 864-244-3862
  • Fax: 864-244-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number5023
License Number StateSC

VIII. Authorized Official

Name: MRS. SHIRLEY MCDONALD
Title or Position: BILLING COORDINATOR
Credential:
Phone: 864-322-4117